Dr. Murray Feingold: The ER has evolved

Wednesday

Jun 22, 2011 at 12:01 AMJun 22, 2011 at 10:16 PM

It was many, many years ago when I was first exposed to an emergency room or ER. It was during my junior year in medical school. Since that time, the use of emergency rooms has dramatically changed. Although there are still trauma cases, an increasing number of patients now use the ER as their family doctor.

Dr. Murray Feingold

It was many, many years ago when I was first exposed to an emergency room or ER. It was during my junior year in medical school.

I thought it would be enjoyable to spend a summer on Cape Cod so I volunteered to work as an extern (no, not an intern) at the Cape Cod Hospital. Among my duties was to help cover the emergency room with my supervising physician who just completed his residency and was waiting to go into practice.

Also available were community physicians who took turns being "on call" to see ER patients. Very few specialists were available at that time, and the more serious cases were sent to Boston hospitals by ambulance.

Trauma cases such as automobile accidents, cuts and bruises, and severe sunburns, were the common reasons for visits to the ER.

It was during this experience that I first learned how to remove a misguided fish hook dangling from the hand of a novice fisherman.

Since that time, the use of emergency rooms has dramatically changed. Although there are still trauma cases, an increasing number of patients now use the ER as their family doctor.

This has led to severe overcrowding and long waits.

Physicians who now staff the ER have also changed. Today, usually well-trained, board-certified emergency physicians manage the care of ER patients.

The types of illnesses that are seen in the ER have expanded tremendously -- less trauma and more medical illnesses.

A recent study showed that ERs manage 11 percent of all outpatient visits and 28 percent of all acute care visits. Fifty percent of all hospital admissions come from the ER.

Two of the reasons for this huge influx of patients are: ERs are mandated to care for all patients who come to the ER, including Medicaid patients; and doctors are not as available to their patients as in the past, so the ER is a common place for them to go to receive medical care.

To manage all of this "patient traffic" and varied diagnoses, sophisticated medical equipment is now necessary, including the latest scanners.

Various medical teams are available in the wings to respond when needed to treat the most serious diseases or extensive trauma.

ERs have come a long way from my days covering the Cape Cod Hospital emergency room. Today, the care is better and more sophisticated.

But in my day, the wait was usually shorter.

Massachusetts-based Dr. Murray Feingold is the physician in chief of The Feingold Center for Children, medical editor of WBZ-TV and WBZ radio, and president of the Genesis Fund. The Genesis Fund is a nonprofit organization that funds the care of children born with birth defects, mental retardation and genetic diseases.